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Finals > Paediatric respiratory > Flashcards

Paediatric respiratory Flashcards

1
Q

Explain the different age groups affected by bronchiolitis, viral induced wheeze and asthma

A
  • > Bronchiolitis : 6mns usually (less than <1 yr)
  • > Viral induced wheeze : <3 years
  • > Asthma : >3 years
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2
Q

What is the most common viral cause of bronchiolitis ?

A

-RSV -> respiratory syncytial virus

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3
Q

What can be given to high risk babies to protect against bronchiolitis

A
  • Palivizumab -> monoclonal antibody targeting RSV.

- Given as a monthly IM injection

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4
Q

How does bronchiolitis present ?

A
  • Wheeze and crackles
  • Coryzal symptoms
  • Tachypnoea
  • Dyspnoea
  • Dry cough
  • Poor feeding
  • Mild fever
  • Apnoeas
  • Signs of respiratory distress
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5
Q

what would suggest a diagnosis of pneumonia over bronchiolitis ?

A
  • High fever (>39 degrees)
  • Persistently focal crackles
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6
Q

What 6 factors would suggest admission to hospital for bronchiolitis ?

A
  • Oxygen at 92% or below
  • RR >70
  • Moderate to severe resp distress
  • 50-75% less of nomral milk intake
  • Apnoea
  • Clinical dehydration
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7
Q

How is bronchiolitis managed in hospital ?

A

Supportive

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8
Q

What is the stepwise approach to ventilation support in bronchiolitis ?

A
  1. High-flow humidified oxygen via tight nasal cannula
  2. Continuous positive airway pressure
  3. Intubation and ventilation
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9
Q

Define croup

A

-Acute, infective, URTI causing oedema of the larynx

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10
Q

What age group does croup typically affect?

A

-6mnths to 2yrs

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11
Q

What is the most common cause of croup?

A

-Parainfluenzae

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12
Q

Give 5 symptoms of croup

A
  • ‘Barking’ cough
  • Stridor
  • Low grade fever
  • Hoarse voice
  • Increased work of breathing
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13
Q

How is croup managed if more than supportive care is needed ?

A
  • Oral dexamethasone (single dose of 0.15mg/kg)
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14
Q

What is determined as mild croup

A
  • Occasional barking cough
  • No audible stridor at rest
  • No or mild suprasternal or intercostal recession
  • Child is happy and prepared to eat, drink and play
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15
Q

What is defined as moderate croup

A
  • Frequent barking cough
  • Easily audible stridor at rest
  • Suprasternal and sternal wall retraction at rest
  • No or little distress and agitation
  • Child can be placated and is interest in its surroundings
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16
Q

What is defined as severe croup

A
  • Frequent barking cough
  • Prominent inspiratory stridor
  • Marked sternal wall retractions
  • Significant distress and agitation, or lethargy or restlessness
  • Tachycardia and hypoxaemia
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17
Q

Give the stepwise management of croup

A
  • Oral dex
  • Oxygen
  • Nebulised budenoside
  • Nebulised adrenaline
  • Intubation and ventilation
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18
Q

Give the normal RR based on age

A
  • <1 yr : 30-40
  • 1-2 yrs : 25-35
  • 2-5 yrs : 25-30
  • 5-12 yrs : 20-25
  • > 12 yrs : 15-20
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19
Q

Give 8 signs of resp distress

A
  1. Raised resp rate
  2. Use of accessory muscles
  3. Intercostal and subcostal recessions
  4. Nasal flaring
  5. Head bobbing
  6. Tracheal tug
  7. Cyanosis
  8. Abnormal airway noises : wheeze, stridor, grunting
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20
Q

What is whopping cough and what causes it ?

A
  • URTI
  • Bordetella pertussis (gram neg)
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21
Q

How does whooping cough present ?

A
  • 1 wk Preceding coryza
  • 3- 6 wks severe paroxysmal coughing fits with large inspiratory whoop.
  • Possible apnoea presentation
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22
Q

How is pertussis diagnosed ?

A
  • Nasal swab with PCR testing or bacterial culture within 2 to 3 wks of symptoms
  • If cough present for >2 wks : anti-pertussis toxin immunoglobulin G on oral fluid aged 5-16 and blood if >17
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23
Q

How is whooping cough managed ?

A
  • <6 mnths. = admit
  • Oral macrolide if within 21 days of cough (erythromycin)
  • Household prophylaxis
  • School exlusion : 48 hrs after starting Abx
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24
Q

What is a key complication of whooping cough ?

A

-Bronchiectasis

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25
Q

What causes laryngomalacia

A
  • Congenital short and soft aryepiglottic folds making the epiglottis ‘omega’ shaped.
  • Causes obstruction
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26
Q

How does laryngomalacia present ?

A
  • Intermittent inspiratory stridor worse when : upset, lying on back or URTI. Worse on feeding in the exam q.
  • Peaks at 6 mnths
  • Usually self resolves
27
Q

What is Primary ciliary dyskinesia? (PCD)

A
  • Autosommal recessive condition causing dysfunction in motile cilia
28
Q

Who does PCD effect ?

A
  • Communities where consanguinity is present
29
Q

what is Kartagner’s triad often seen in PCD?

A
  • Paranasal sinusitis
  • Bronchiectasis
  • Situs Inversus
30
Q

What kind of hypersensitivity reaction is asthma/other atopic conditions ?

A
  • Type 1
  • IgE mediated
31
Q

Explain the pathophysiology behind asthma

A
  • Environmental trigger
  • Smooth muscle is hypersensitive = bronchospasm and constriction
  • Increased mucus secretion – Causes airway obstruction
32
Q

Give the common signs and symptoms of asthma (4)

A
  • Episodic symptoms with intermittent exacerbations
  • Diurnal variability, typically worse at night and early morning
  • Dry cough with wheeze and shortness of breath
  • Bilateral widespread “polyphonic” wheeze
33
Q

Give 6 common triggers of asthma

A
  • Dust
  • Animals
  • Cold air
  • Exercise
  • Smoke
  • Food allergens
34
Q

How is chronic asthma managed in an under 5 ?

A
  • Short-acting beta-2 agonist inhaler (e.g. salbutamol) as required.
  • Add a low dose corticosteroid inhaler or a leukotriene antagonist (i.e. oral montelukast)
  • Add the other option from step 2.
  • Refer to a specialist.
35
Q

How is chronic asthma managed in a 5-12 year old child ?

A
  • Salbutamol
  • Add a regular low dose corticosteroid inhaler
  • Add a long-acting beta-2 agonist inhaler (e.g. salmeterol).
  • Titrate up the corticosteroid inhaler to a medium dose.
    -Consider adding:
    Oral leukotriene receptor antagonist (e.g. montelukast) or oral theophylline
  • Increase the dose of the inhaled corticosteroid to a high dose.
36
Q

How is chronic asthma managed in a child over 12?

A
  • Salbutamol
  • Add low dose ICS
  • Add a long-acting beta-2 agonist inhaler (e.g. salmeterol).
  • Titrate up the ICS to a medium dose.
  • Consider a trial of an oral leukotriene receptor antagonist (i.e. montelukast), oral theophylline or an inhaled LAMA (i.e. tiotropium).
  • Titrate the inhaled corticosteroid up to a high dose.
  • Combine additional treatments from step 4, including the option of an oral beta 2 agonist (i.e. oral salbutamol).
37
Q

What is the step up of bronchodilators

A
  1. Inhaled or nebulised salbutamol
  2. Inhaled or nebulised ipratropium bromide
  3. IV mag sulph
  4. IV aminophylline
38
Q

How is a mild asthma attack managed ?

A
  • Salbutamol inhalers via spacer
39
Q

How is a moderate to severe asthma attack managed ?

A
  1. Salbutamol via spacer
  2. Nebulised salbutamol / ipratropium bromide
  3. Oral pred
  4. IV hydrocortisone
  5. IV mag sulph
  6. IV salbutamol
  7. IV aminophylline
40
Q

what is pneumonia and what is seen on a chest X-ray ?

A
  • Infection of the lung tissue
  • Consolidation due to pus in the lungs
41
Q

Give 2 symptoms of pneumonia

A
  • High fever (>38.5)
  • Cough : wet and productive
42
Q

Give 3 characteristic chest signs of pneumonia

A
  • Bronchial breath sounds
  • Focal coarse crackles
  • Dullness to percussion
43
Q

Give the most common bacterial and viral cause of pneumonia

A
  • Bacterial : strep pneumonia
  • Viral : RSV
44
Q

How is pneumonia managed ? (dosage in child >11)

A
  • Amoxacillin (500mg 3x daily)
  • Add macrolide if atypical
45
Q

What was the most common cause of epiglottitis prior to vaccination programmes ?

A
  • Haemophilus influenza type B
46
Q

How does epiglottitis present ?

A
  • Severe sore throat
  • Inspiratory stridor
  • Drooling and protruding tongue
  • Tripod position
  • High fever
  • Difficult and painful swallow
  • Muffled voice
47
Q

How is epiglottitis managed ?

A
  • SECURE AIRWAY
  • IV antibiotics
  • Steroids if necessary.
48
Q

What is cystic fibrosis ?

A

-Autosomal recessive condition affecting the mucus glands, most commonly caused by Delta-F508 mutation of CFTR gene on chromosome 7

49
Q

How is CF diagnosed ?

A
  • Newborn bloodspot test
  • Sweat test : gold standard
50
Q

What is an early sign of CF

A
  • Meconium ileus
51
Q

Give 6 symptoms of CF

A
  • Chronic cough
  • Thick sputum production
  • Recurrent resp tract infections
  • Steatorrhoea
  • Abdo pain and bloating
  • Salty taste to child
  • Failure to thrive
52
Q

Give 5 signs of CF

A
  • Low weight or height on growth charts
  • Nasal polyps
  • Finger clubbing
  • Crackles and wheeze on auscultation
  • Abdo distention
53
Q

What is the gold standard test for CF?

A
  • Sweat test
54
Q

What chloride concentration is diagnostic for CF on a sweat test

A

> 60mmol/L

55
Q

What are 2 common microbial colonisers in people with CF?

A
  • Staph aureus : long term prophylactic flucloxacillin taken
  • Psuedomonas aeruginosa : treated with nebulised tobramycin
56
Q

what is a common finding in CF in a male

A

Bilateral absence of vas deferens

57
Q

How is epiglottitis confirmed ?

A
  • Direct visualisation (only by senior/airway trained staff).
  • X ray : lateral = ‘thumbprint sign’
58
Q

Explain the basics of paediatric life support

A
  • Unresponsive?
  • Shout for help
  • Open airway
  • Look, listen, feel for breathing
  • Give 5 rescue breaths
  • Check for signs of circulation
    infants use brachial or femoral pulse, children use femoral pulse
  • 15 chest compressions:2 rescue breaths
59
Q

Explain the key features of chest compressions in children

A
  • Chest compressions should be 100-120/min for both infants and children
    depth
  • Depress the lower half of the sternum by at least one-third of the anterior–posterior dimension of the chest
60
Q

What 3 features suggest a diagnosis of viral induced wheeze over asthma ?

A
  • Presenting <3 yrs
  • NO atopic history
  • Only occurs during vital infections
61
Q

What is CLDP ?

A
  • Premature babies (usually <28 wks gestation) suffer with respiratory distress syndrome and require O2 therapy or intubation and ventilation
62
Q

Diet recommended in pts with CF

A
  • High calories, high fat and pancreatic enzyme supplementation for every meal
63
Q
A

Finals (92 decks)

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